The Treatment of Mental Illness in the Early 19th Century

There is not a lot of overt madness in Jane Austen (though you do find plenty of eccentricity). Still, for some inexplicable reason, I keep coming back to it in my writing. Well, maybe it’s not so inexplicable. I’ve been fairly obsessed with the subject since my early teen years, compelled by both my own and several members of my family’s battles for mental health, so it’s really not that surprising that it keeps cropping up in my work.

In my newest book, Being Mrs. Bennet (more on it next month), the main character finds herself inhabiting the body of Mrs. Bennet following a car accident. Under such circumstances, how could she not question her sanity? Again and again, both she and her ersatz family worry for her mental health. In my last full length novel, Darcy In Wonderland, it is Austen’s hero who keeps wondering if he has lost his mind, after following his precocious daughter down Lewis Carroll’s rabbit hole. Wouldn’t you fear for your mind when confronted by random growth fluctuations and talking animals? Yet it is only in The Madness of Mr. Darcy that I’ve allowed the topic to take center stage. The book takes place in 1832, more than twenty years after the events of Pride & Prejudice, and imagines what might have happened if Lydia and Wickham parted ways before Mr. Darcy could find them and force a marriage. The years have been hard on our hero, in no small part because of the loss of his true love, Elizabeth Bennet. The Madness of Mr. Darcy reunites them in the most unlikely of locations: Ramsey House, a private asylum for the unhinged genteel. Mr. Darcy finds himself there after committing an uncontrolled act of violence, surrounded by some familiar characters (this is John Knightley speaking in the quote below).

“I have heard of it before. In whose hands do you trust it while here?”

“My cousin, Lord Matlock’s.”

“Then you have nothing to fear. Fitzwilliam already has too much to possibly require any more. Besides, is not his son your heir?” Darcy nodded to the earl in affirmation. “I think your assets are in rather safe hands.”

“Is it common for relations to seize estates while their owners are … indisposed? One hears of such things, of course, but I admit to thinking such accounts more sensational than representative.”

“Such things do happen, though you are right – it is not common. Nevertheless, certain persons of influence have been pushing to codify into law the rights of those, like us, who find themselves incapable of handling their own affairs,” Mr. Knightley said, with a hint of bitterness in his voice. “It is a cause I should have liked to take up.”

Bedlam depiction from “The Rakes Progress” by William Hogarth

By the 1830s, private asylums had a very bad public image. Before the 19th century, there were no public asylums in England at all except the infamous Bedlam, more formally referred to as Bethlem Royal Hospital, which had been in operation in one form or the other since 1247. Over the centuries little progress was made in what we now call the mental health. Lunatics (a technical term) were confined and restrained as needed to prevent harm to others. There was little notion of treatment or any attempt to cure. Bedlam couldn’t house all the lunatics in Britain, and a prosperous industry developed housing them in private homes. A private madhouse could hold anywhere from one or two inmates to hundreds, and those who profited from them seldom had interest in or knowledge of medicine. Healing these poor inmates would be bad for business, and there was no one to hold the owners of asylums accountable for their “treatments” but the families who had confined relations to their care.

I would be remiss if I didn’t pause to note that this is the same manner in which many other inconvenient relations, like the mentally, developmentally, or physically challenged, were treated, including Jane Austen’s brother, George, who was sent to live with another family at a young age and seems to have been seldom thought of again.

The situation was beginning to improve in the 18th century. Doctors became interested in actually treating madness as a disease, though it would not be until the 1845 Lunacy Act that the insane would be legally considered patients. A few notorious cases of abuse mid-century led to the Madhouse Act of 1774, which required asylums be licensed, inspected annually, and instituted fees for holding unregistered inmates. George III’s illness increased attention and interest in treating madness instead of just containing it, and a new breed of private asylums flourished, forsaking restraints and chains for “moral therapy,” which strove to rehabilitate the insane through country settings, labor, and reinforcement of routine. Despite reforms, public paranoia regarding private asylums continued to increase, and the 1808 County Asylums Act paved the way for the first public asylums outside of London. Though abuse surely diminished in the private facilities, increased scrutiny revealed more, and a few sensational cases held a pretty tight grasp on the public’s imagination. The Madhouses Act of 1828 brought metropolitan asylums under the oversight of the new Commission in Lunacy, and an 1832 act further refined the legislation. The 1845 act gave the final death blow to the private asylum when it required every county to build a public asylum for paupers. Enormous institutional structures, designed to resemble country homes in all but their monstrous proportions, cropped up all over England, and the only private asylums left in business were those like my Ramsey House, catering to an elite clientele. New attempts to cure the insane led to new abuses, in some ways all the more horrific for being sanctioned by medical authority. Nevertheless, the significance of these early attempts to understand the mind and treat the mentally ill should not be underestimated. It was the birth of psychiatry, a field which continues to evolve and often as the result of legislation rather than medical advancement. While The Madness of Mr. Darcy’s Ramsey House is entirely the product of my imagination, I based it upon what we know of such institutions at the time: a private madhouse, functioning under moral therapeutic principals, flourishing and yet, in all likelihood, on the verge of extinction.

Image of late 19th century inmates dancing at the Monrose Royal Asylum, Scotland

I imagine I will continue to tackle the subject of insanity in my future works. I can’t quite seem to escape it. It both fascinates and terrifies me, as it does my characters. I hope you found this brief survey both useful and compelling. Happy spring!

13 Responses to The Treatment of Mental Illness in the Early 19th Century

Very interesting. Thank the Lord that we live in these times. My daughter has a serious mental illness and it’s been really hard going over the last seven years. But her treatment has been brilliant and I have nothing but praise for her doctors, especially her psychiatrist. He’s a lovely man.

When the Madness of Mr. Darcy came out, I read it due to me being in the nursing profession and wanted to see the difference in care. I did enjoy the writing and information given to me. I am grateful for authors that do the research so we can not only learn but enjoy reading. Thank you for the information once again and look forward to your next novel!

Thanks, MaryAnn! I’ve studied the topic for a long time, so it was easy to contract the story around the information I already had at my disposal. I would love, LOVE to do original research for a novel. Maybe someday.

Fascinating! Of course I read “The madness” and felt you gave Darcy an unconventional treatment for the time which was so interesting. Then I read the first draft of Mrs. Bennet and I’m dying to know how you worked that one out in the grand finale. Looking forward to your new book and I thoroughly enjoy your explorations into mental Illness. Hope you are feeling good after the new baby and happy to see you are putting out the new book. Jen Red

Thanks, Jen! I feel great and Jack is an absolute doll. Just adore him. It was tough with Mr. Darcy as he is so independent. Much harder to institutionalize a person in his position at the time. I had to come up with a treatment he would submit to, or make him foaming-at-the-mouth bonkers. Didn’t think the latter notion would appeal to many. ?

Lovely overview! I know very little about the history of mental health in England, but a bit more on the US side, since my husband is a psychiatrist. It’s a constantly developing field, and it’s interesting too!

I find it a source of endless fascination. We still know so little about the human brain and why it does what it does. Each person is so unique to begin with and then becomes a product of all their personal experiences. It’s really inpossie to generalize. You can diagnose someone with a syndrome but each manifestation of that illness is singular.

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